Does Acetabulum Remodel Following Varus Derotation Osteotomy for Perthes' Disease?

Deo, Nitish Bikram; Agarwal, Anil

doi:10.1055/s-0043-1772242

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev bras ortop 58 (4) • Jul-Aug 2023 • https://doi.org/10.1055/s-0043-1772242 copy

Does Acetabulum Remodel Following Varus Derotation Osteotomy for Perthes' Disease?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

We investigated the effect of disease stage, patient's age and final contour of femoral head on acetabulum contour following varus derotation osteotomy of proximal femur (VDRO) in unilateral Perthes's disease.

Methods

The study is a retrospective analysis of case records of 23 children aged ≥6 years with unilateral Perthes' disease who underwent primary VDRO procedure for containment. Acetabular index (AI) and center edge angle (CEA) were calculated bilaterally in preoperative and follow-up radiographs and compared statistically.

Results

There were 15 boys and 8 girls. Six hips were in Ib, 8 in IIa and 9 in IIb modified Waldenström stage while undergoing VDRO. The mean age at surgical intervention was 8.7 years. The mean follow-up duration was 3.5 years. All femoral heads were healed at final follow-up and the final Stulberg grades were I = 3, II = 8, III = 7, IV = 5. A significant acetabular dysplasia on the affected side was present preoperatively. At follow-up, the patients operated had significantly raised AI and reduced CEA. There was no significant acetabular remodeling of the affected hips at follow-up even in children operated at younger age (< 8 years) or early stages (stage Ib or IIa). The acetabulum remodeling did not correspond to the final Stulberg grade as well.

Conclusion

Acetabulum was found involved in early stages of Perthes' disease. Varus derotation femoral osteotomy for the diseased hip showed no significant improvement in acetabular dysplasia even when operated in early disease stages or younger age group. Residual acetabular changes were also noted even with favorable Stulberg grades.

Keywords
acetabulum; child; hip joint; legg-calve-perthes disease

S.NO.	SEX	SIDE	AGE (MONTHS)	AGE AT F/U (YEARS)	F/U (MONTHS)	DISEASE STAGE	EXTRUSION	PREOPERATIVE PARAMETERS (DEG.)				FOLLOW UP (DEG.)				STULBERG GRADE
								UNAFFECTED	UNAFFECTED	AFFECTED	AFFECTED	UNAFFECTED	UNAFFECTED	AFFECTED	AFFECTED
								AI	CEA	AI	CEA	AI	CEA	AI	CEA
1	M	R	81	9	20	2b	PRESENT	12	28	22	23	15	30	22	27	II
2	M	R	132	16.6	120	2a	PRESENT	12	30	16	23	18	32	23	26	III
3	M	L	96	12.5	54	1b	ABSENT	11	34	15	26	6	42	12	37	III
4	M	L	122	14.5	51	2a	ABSENT	13	31	15	24	13	44	23	22	III
5	M	R	140	16	54	2b	PRESENT	15	27	16	26	15	36	24	6	IV
6	M	R	102	14.5	60	2b	PRESENT	14	30	16	14	14	30	21	8	IV
7	F	L	96	9.5	14	2b	PRESENT	11	38	15	32	10	39	14	39	II
8	F	R	108	14	55	1b	ABSENT	11	39	28	28	16	45	23	34	II
9	M	L	91	12.5	58	2a	PRESENT	12	33	15	34	15	39	21	22	II
10	F	L	76	10.5	49	2b	PRESENT	7	33	11	27	12	43	17	35	II
11	F	L	96	11.2	38	1b	PRESENT	16	32	20	25	19	32	19	24	III
12	M	R	120	12.6	32	1b	ABSENT	6	34	13	30	9	41	12	29	II
13	M	R	108	17	93	1b	PRESENT	12	30	22	21	11	45	21	30	III
14	M	R	96	12.7	51	2b	PRESENT	15	31	24	18	12	34	13	22	IV
15	M	L	132	14	34	2b	PRESENT	10	33	9	32	12	52	26	32	II
16	M	L	79	10	33	2a	PRESENT	13	34	18	24	6	31	14	32	I
17	F	L	120	11	14	2a	PRESENT	12	52	18	32	13	41	19	39	IV
18	M	L	96	10.5	22	2a	PRESENT	10	38	15	33	9	45	15	24	III
19	F	R	120	11	14	2a	PRESENT	12	26	15	24	16	29	12	34	I
20	M	L	115	11.5	36	1b	PRESENT	13	27	14	23	14	28	15	31	I
21	F	R	84	9.5	17	2b	PRESENT	14	32	20	23	15	26	24	17	II
22	F	L	103	10	17	2b	PRESENT	10	31	14	23	9	34	14	32	III
23	M	L	87	9.5	14	2a	ABSENT	9	32	11	28	11	30	11	26	IV

Groups	Preoperative		Significance^* * Student t-test.	Preoperative		Significance^* * Student t-test.	Follow up		Significance^* * Student t-test.	Follow up		Significance^* * Student t-test.
Groups	Unaffected AI (in degrees)	Affected AI (in degrees)		Unaffected CEA (in degrees)	Affected CEA (in degrees)		Unaffected AI (in degrees)	Affected AI (in degrees)		Unaffected CEA (in degrees)	Affected CEA (in degrees)
Initial stage of disease
Ib, IIa	11.6 (2.1)	17.1 (4.2)	0.0001	33.3 (6.1)	26.5(4.0)	0.0008	12.8(3.9)	17.5(4.5)	0.0004	36.9 (6.5)	29.1 (5.14)	0.002
IIb	12 (2.6)	16.3(4.6)	0.006	31.4 (3.0)	24.2(5.6)	0.002	12.7 (2.1)	19.4(4.8)	0.0007	36 (7.4)	24.2 (11.1)	0.008
Age at time of surgery
≤8 years	11.8 (2.6)	16.9 (4.3)	<0.001	33.2 (2.9)	26.6 (4.9)	0.0001	11.8 (4.0)	16.5 (4.4)	0.0006	35.5 (6.3)	27.7 (7.0)	0.003
>8 years	11.6 (2.2)	16.3(4.5)	0.007	32.5 (6.7)	25 (4.9)	0.001	13.4 (2.6)	19.4 (4.7)	0.0001	38 (7.3)	27 (9.8)	0.005
Stulberg stage at follow up
I andII	11 (2.4)	16.3(5.1)	0.004	32.4 (4.0)	27.2(4.0)	0.001	12.7 (3.1)	18.2(4.9)	0.003	36.6 (8.0)	30.2 (6.0)	0.027
III and IV	12.4 (2.1)	16.8(3.5)	0.0001	33.2 (6.2)	24.4(5.1)	0.0001	12.5 (3.6)	17.9(4.5)	0.0003	37.1 (5.7)	24.7 (9.5)	0.0008

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Nitish Bikram Deo, MS, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu 44600, Nepal. (e-mail: nitishbikram07@gmail.com).